Our colorectal cancer team thoroughly explains your treatment options and provides support throughout your care. Our recommendations typically depend on:
- The tumor’s location and whether it’s fully removable with surgery
- The cancer’s stage (whether it’s just in the lining of the colon or rectum, or has spread to the tissue wall, lymph nodes, or other parts of the body)
- Whether the cancer has blocked the colon or made a hole in it
- Whether the cancer is a new diagnosis or has returned
- Your overall health
Our researchers have also identified more than 50 different genetic mutations in colorectal tumors that can dictate how well they respond to treatment.
Surgery options for colorectal cancer
Surgery is usually the cornerstone of colorectal cancer treatment, with the goal to remove the tumor, or as much of it as possible. Several types include:
- Local excision: Early-stage tumors are taken out through the rectum (with the removal of a polyp(s), called a polypectomy, often done during colonoscopy) via the insertion of a thin tube with a light and camera
- Resection: Larger tumors are taken out through an abdominal incision, with all or part of the larger intestine taken out for colon cancer (partial or full colectomy) and possibly some surrounding tissue for rectal cancer. Lymph nodes are also usually taken out and checked for spread of the cancer
- Anastomosis: The healthy parts of the colon or rectum are sewn back together; the colon is sewn to the anus or the remaining rectum is sewn to the colon to restore bowel function
- Colostomy: When the colon or rectum can’t be reattached, your doctor creates an opening (stoma) and attaches a bag to collect waste. Sometimes a colostomy is just needed until healing can take place; at other times, it’s permanent.
- Minimally invasive surgery represents a newer approach and offers a shorter hospital stay and recovery, as well as less bleeding during surgery and less post-operative pain. We offer several minimally invasive options:
- Laparoscopic colectomy: Instead of a large abdominal incision, your surgeon makes several smaller ones and inserts a light, camera, and special instruments to remove the tumor. We try to use this approach whenever possible
- Robotic-assisted surgery: Robotic-assisted surgery uses laparoscopic tools, but incorporates robotic arms controlled by the surgeon. We use this technique on a number of rectal tumors
- Transanal endoscopic microsurgery (TEM): Doctors insert a microscope-equipped surgical instrument through the anus, reaching tumors high inside the rectum that were previously only accessible through an abdominal incision.
Late-stage colorectal surgery
Our experienced specialists can also remove parts of other organs, such as the liver, lungs, and ovaries, when colorectal cancer has spread or returned. In addition to conventional surgery, liver options include:
- Radiofrequency ablation: Uses a special probe with tiny electrodes to kill the cancer cells
- Cryosurgery: Freezes and destroys abnormal tissue
Chemotherapy uses drugs to stop cancer cells, either by killing them or preventing them from dividing. It is given as a pill or injection to reach cells throughout the body via the bloodstream (systemic chemotherapy) or placed directly into an organ or cavity (regional chemotherapy).
We give chemotherapy by itself to relieve late-stage symptoms, or before, during, or after surgery —including a promising approach for otherwise incurable tumors called hyperthermic intraperitoneal chemotherapy, or HIPEC. While colorectal cancers can quickly develop a tolerance to today’s chemotherapies, we’re working to tailor care for individual tumors. We’re also exploring:
- New drugs, or those already used against other cancers
- New ways to combine drugs to improve their effectiveness
- The best ways to combine chemotherapy with radiation and targeted therapy
Hyperthermic intraperitoneal chemotherapy (HIPEC)
In the past, traditional therapy failed for up to 20 percent of patients with gastrointestinal cancer, including colorectal disease. But one of our clinical trials is studying a promising approach called hyperthermic intraperitoneal chemotherapy (HIPEC), delivered by Dr. Paul Sugarbaker — a co-developer of the technique and one of the world’s leading experts.
Here’s how it works:
- The primary tumor is removed using the least invasive method possible, but any cancer that has spread to the lining of the abdominal cavity (the peritoneum) is left in place
- Patients usually take chemotherapy at home and then recuperate
- Doctors surgically remove all visible, remaining cancer with a special electroevaporative technique (cytoreductive surgery, or debulking)
- Before the operation ends, chemotherapy is heated to make it more effective, then applied directly to the surgical site while doctors manipulate the organs to control distribution. This allows a higher dose of chemotherapy while minimizing side effects
- A catheter is placed for any further chemotherapy and the surgical site is repaired
Dr. Sugarbaker has so far performed surgery with HIPEC on several hundred patients with colorectal cancer, and he estimates that 10 percent of those with the disease could benefit. He believes the procedure is most effect when patients are:
- Otherwise healthy
- Faced with a limited number of metastases (tumors that have spread)
When colorectal cancer has spread to the liver, our doctors can block the hepatic artery leading to the organ and inject chemotherapy drugs directly. This chemoembolization helps treat the liver while preventing most of the drug(s) from reaching other parts of the body.
Radiation therapy uses high-energy X-rays or other radiation to kill cancer cells. There are two types:
- External: delivered by a machine outside the body
- Internal (brachytherapy): radioactive substances sealed in needles, seeds, wires, or catheters are placed directly in or near the cancer
The method depends on the type and stage of the cancer. We use internal radiation when cancer has spread to the liver, and external as a way to control symptoms in late-stage colorectal cancer. Radiation is also a stand-alone treatment option for early-stage rectal cancer, or combined with surgery and possibly chemotherapy.
One of the most promising approaches for treating colorectal cancer is targeted therapy, a way to single out specific molecules that help the disease grow and spread. These drugs and other substances can potentially provide a less toxic but still potent treatment, and we offer both approved therapies and clinical trials.
Some types of targeted therapy for colorectal cancer include:
- Monoclonal antibodies: made from immune system cells (an immunotherapy), they target specific substances on cancer cells and then kill them, block their growth, or keep them from spreading
- Angiogenesis inhibitors: stop the growth of new blood vessels needed by tumors